title: Comparison of the diagnostic performances of diffusion parameters in diffusion weighted imaging and diffusion tensor imaging of breast lesions.
abstract: OBJECTIVE
  To evaluate the diagnostic efficiency of the diffusion parameters measured by conventional diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) for discrimination of malignant breast lesions from benign lesions and the normal breast.
  
  
  METHODS
  The study included 52 women with 55 breast lesions (30 malignant, 25 benign). DTI and DWI were performed complementary to dynamic contrast MRI at 3T. Apparent diffusion coefficient (ADC) of DWI, mean diffusivity (MD) and fractional anisotropy (FA) values of DTI were measured for lesions and contralateral breast parenchyma in each patient. We used b factors of 0, 50, 850, 1000 and 1500 s/mm(2) for DWI and b 0 and 1000 s/mm(2) for DTI. ADC, MD and FA values were compared between malignant and benign lesions, and the normal parenchyma by univariate and multivariate analyses.
  
  
  RESULTS
  Diffusion parameters showed no difference according to menopausal status in the normal breast. ADC and MD values of the malignant lesions were significantly lower than benign lesions and normal parenchyma (p=0.001). The FA showed no statistical significance. With the cut-off values of ≤ 1.23 × 10(-3)mm(2)/s (b 0-1000 s/mm(2)) and ≤ 1.12 × 10(-3)mm(2)/s (b 0-1500 s/mm(2)), ADC showed 92.85% and 96.15% sensitivity; 72.22% and 73.52% PPV, respectively. With a cut-off value of ≤ 1.27 × 10(-3)mm(2)/s (b 1000 s/mm(2)), MD was 100% sensitive with a PPV of 65.90%. Comparing the diagnostic performance of the parameters in DTI with DWI, we obtained similar efficiency of ADC with b values of 0,1000 and 0,1500 s/mm(2) and MD with a b value of 0, 1000 s/mm(2) (AUC = 0.82 ± 0.07).
  
  
  CONCLUSIONS
  ADC of DWI and MD of DTI values provide significant discriminative factors for benign and malignant breast lesions. FA measurement was not discriminative. Supported with clinical and dynamic contrast MRI findings, DWI and DTI findings provide significant contribution to the final radiologic decision.
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Radiology, 41380 Kocaeli, Turkey. Electronic address: cakirozgur@hotmail.com.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Cakir
authors.forename: Arzu
authors.initials: A
authors.lastname: Arslan
authors.forename: Nagihan
authors.initials: N
authors.lastname: Inan
authors.forename: Yonca
authors.initials: Y
authors.lastname: Anık
authors.forename: Tahsin
authors.initials: T
authors.lastname: Sarısoy
authors.forename: Sevtap
authors.initials: S
authors.lastname: Gumustas
authors.forename: Gur
authors.initials: G
authors.lastname: Akansel
mesh_terms: D000368:Aged; D000465:Algorithms; D001941:Breast Diseases / Q000175:diagnosis*; D001943:Breast Neoplasms / Q000175:diagnosis; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Breast cancer; Diffusion tensor imaging, DTI, Apparent diffusion coefficient, ADC; Diffusion weighted imaging (DWI); Fractional anisotropy, FA; Mean diffusivity, MD